(1287) Impact of Removing Rapid Shallow Breathing Index From Weaning Protocol on Clinical Outcomes

Sunday, February 23, 2025

2:30pm – 3:30pm Eastern Time

Location: Connections Central - RST 13

First Author(s)

JK

Joseph Kowalczyk, RRT (he/him/his)

Mercy Hospital Saint Louis
Saint Louis, Missouri, United States

Co-Author(s)

DL

Danny Lutz, RRT

Wildwood, Missouri, United States
AG

Alison Gildehaus, MD,

Trauma Medical Director
n/a, United States
AJ

Abbie Jensen, MD

Trauma ICU Medical Director
Mercy Hospital St Louis, United States
AK

Anup Katyal, MD

Med-Surg ICU Medical Director
Mercy Hospital Saint Louis, United States
WM

Walter Mickey, DO

Neuroscience ICU Medical Director
Saint Johns Mercy Hospital, United States
VS

Vinaya Sermadevi, MD

CVICU Medical Director
Mercy Hospital Saint Louis, Missouri, United States
AS

Anil Srivastava, MD, FACS

Trauma, Acute Care Surgery, & Surgical Critical Care
Mercy Clinic, United States
KF

Kimberly Fowler, BSN, RN

Research Coordinator
Mercy Hospital Saint Louis, United States
FS

Farid Sadaka, MD

Critical Care Department Chairman
Mercy Hospital St Louis
Saint Louis, MO, United States

Introduction: Invasive mechanical ventilation (IMV) is lifesaving for patients with acute respiratory failure, but it is associated with substantial risks. As patients recover, efforts focus on liberating from IMV. The rapid shallow breathing index (RSBI: frequency/tidal volume) is used to support decision-making during weaning and to predict the likelihood of successful liberation from IMV.

Methods: Patients are screened daily for measures of oxygenation, ventilation, cough and secretions, mental status, and hemodynamic stability. The protocol included measurement of RSBI, using a threshold of 105. Patients passing the screen receive a spontaneous breathing trial (SBT). Patients passing SBT are eligible for an extubation trial. The QI project assessed the removal of RSBI from the protocol on clinical outcomes. All data were retrospectively collected from electronic health record (EPIC) and APACHE outcome database on patients admitted to ICU (26 Trauma-Neuro ICU beds, and 24 Med-Surg ICU beds) between 6/2021 and 6/2023. Patients transitioned to comfort care and considered dead by neurologic criteria (brain dead) were excluded.

Results: The intervention was implemented in 6/2022. A total of 1646 patients were included (788 before and 858 after). The before and after groups had similar age (56 +/- 18 vs 56 +/- 19, p = 1.0), gender (female: 44 % vs 43.5 %, p = 0.8), APACHE IV scores (57 +/- 27 vs 57 +/- 29, p = 1.0), and acute physiologic scores (APS; 48 +/- 25 vs 48 +/- 26, p = 1.0). The after group had less days with endotracheal (ET) tube (2.6 +/- 3.0 vs 3.4 +/- 4.0, p = 0.0001), less days of mechanical ventilation (3.9 +/- 4.3 vs 4.9 +/- 5.3, p = 0.0001), less ICU LOS in days (6 +/- 5 vs 7 +/- 6, p = 0.0002), less hospital LOS (13.8 +/- 11.0 vs 16 +/- 13, p = 0.0002), similar re-intubation rate (10.7 % vs 10.4 %, p = 0.8), similar tracheostomy rate (21.2 % vs 21.4 %, p = 0.9), and similar mortality (8.5 % vs 9.0 %, p = 0.7).

Conclusions: The removal of RSBI from the weaning protocol for patients on IMV resulted in significant improvements in clinical outcomes. These findings suggest that eliminating RSBI from the weaning protocol can enhance patient recovery and resource utilization in the ICU. Further studies are warranted to validate these results across different ICU settings and patient populations.